Original ArticleDrug-induced sedation endoscopy in pediatric obstructive sleep apnea syndrome☆
Introduction
Obstructive sleep apnea syndrome (OSAS) is a frequent condition in otherwise healthy children with an overall prevalence of 1% to 4% [1] and adenotonsillectomy (ATE) is the primary treatment for pediatric OSAS. Although an improvement in polysomnographic (PSG) parameters is observed in the vast majority, 13–29% of children in a relatively low-risk population have persistent OSAS defined as an apnea/hypopnea index (AHI) ≥ 5/h [2], [3].
In adults, upper airway (UA) endoscopy during sedation – also called drug-induced sedation endoscopy (DISE) – is considered a valuable tool in selecting patients for UA surgery or oral appliance therapy [4]. Recently, it was shown that the outcome of UA surgery in adults may be at least partially determined by DISE findings [5].
The use of DISE in children with complex UA obstruction was first described in 2000 by Myatt and Beckenham [6]. Fishman et al. compared DISE with awake endoscopy in children with persistent OSAS following ATE and concluded that DISE has a better interobserver correlation for the nasopharynx and supraglottis, and identifies more cases of obstruction located at the nasopharynx, lateral pharyngeal wallstongue base, and supraglottis [7]. Truong et al. [8] reported the reliability of pediatric DISE in a heterogeneous group of 80 patients and DISE-directed treatment outcomes in 35 children undergoing ATE. However, 28.2% of the subjects. were considered hypotonic or had syndromic comorbidities [8]. Prospective studies on outcomes following DISE-directed treatment in surgically naive patients without comorbidity or craniofacial abnormalities are presently not available in the pediatric OSAS population.
Since July 2011, we have routinely performed DISE in children diagnosed with OSAS and considered candidates for UA surgery.
We conducted a prospective study with the following aims: (1) to describe the pattern of UA obstruction observed during DISE in children with OSAS without previous UA surgery for snoring or OSAS, defined as surgically naive and without craniofacial anomalies or syndromes associated with OSAS; (2) to evaluate outcomes in those selected for UA surgery based upon UA findings during DISE.
Section snippets
Methods
All children meeting the inclusion criteria and scheduled for DISE between July 2011 and August 2013 were prospectively enrolled. Inclusion criteria were a diagnosis of OSAS and no previous history of adenoidectomy and/or tonsillectomy for OSAS. Children with an underlying medical condition or syndrome associated with OSAS and possibly affecting UA morphology, such as craniofacial malformations and trisomy 21, were excluded.
Diagnosis of OSAS was based upon a combination of clinical signs and
Results
Thirty-seven children meeting the inclusion criteria underwent DISE examination during the study period. The study group consisted of 10 girls and 27 boys, aged 4.1 (2.1–6.0) years, BMI 16.20 kg/m2 (14.9–15.70), and BMI z-score 0.3 (−0.9 to 0.9). The study population presented with moderate to severe OSAS with oAHI 9.0 (6.1–19.3)/h, mean oxygen saturation (meanSat) of 96.8% (96.0–97.5), and minimum oxygen saturation (minSat) of 89.0% (85.0–93.0).
There were no adverse events during DISE and none
Discussion
We report data on a homogeneous group of OSAS children without a history of previous upper airway surgery and without syndromic comorbidity or craniofacial abnormalities. In addition, we provide outcome data on DISE-directed surgery.
Truong et al. [8] reported DISE-directed treatment outcomes in 35 children undergoing ATE but 28.2% of these subjects were considered hypotonic or had syndromic comorbidities.
Therefore, our paper may be considered the first report on DISE findings and treatment
Conflict of interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2014.06.016.
. ICMJE Form for Disclosure of Potential Conflicts of Interest form.
Acknowledgments
The authors would like to thank Miss Kristien Wouters, statistician at the University Hospital Antwerp for her help with the figures and data management. We are also indebted to Prof. Dr. O. Vanderveken, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Antwerp, for his critical review of the manuscript.
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Cited by (0)
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The results of this study were presented in part at the European Respiratory Society Annual Congress, Barcelona, Spain, 7–11 September, 2013; Abstract 850814.